Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Objectives:To evaluate the efficacy and safety of adalimumab (ADA) biosimilar in the treatment of Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. The patients with CD treated with ADA biosimilar in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to March 2022 with complete data were enrolled. The disease activity of patients at baseline was evaluated by Harvey-Bradshaw index (HBI) . The patients were divided into active group and remission group according to the activity. The primary endpoints were clinical response rate and remission rate at the 12th week in patients with active CD. The secondary endpoints included the clinical response rate and the remission rate in patients with active CD at the 26th week, maintenance remission rate at the 12th and the 26th weeks in patients with remission CD, and safety report.Results:Forty-eight patients were included. There were 20 patients whose HBI was 7 (6, 8) points in active group and 28 whose HBI was 3 (2, 4) points in remission group. In patients with active CD, the clinical response rate was 70.0% (14/20) and clinical remission rate was 60.0% (12/20) at the 12th week. The clinical response rate and clinical remission rate were both 61.5% (8/13) at the 26th week. The maintain remission rate of patients with remission CD was 96.4% (27/28) and 92.3% (12/13) at the 12th and the 26th weeks respectively. During the follow-up period, adverse reactions occurred in 2 patients (4.2%) and no serious adverse reaction was found.Conclusion:ADA biosimilar has good efficacy and safety in short-term induction and maintenance of clinical remission in Chinese patients with mild to moderate active CD.

Objective:To investigate the effect of exclusive enteral nutrition (EEN) on plasma amino acid levels in patients with Crohn′s disease (CD) .Methods:Adult patients with moderate to severe active CD in the Sixth Affiliated Hospital of Sun Yat-sen University from December 1, 2020 to December 31, 2021 were prospectively recruited. All the participants received nasogastric EEN monotherapy for 8 weeks. Patients were divided into clinical response group and non-response group according to CD activity index (CDAI). Clinical data were collected from all the participants before and after EEN. Targeted metabolomics was used to detect and analyze the changes of 25 amino acids levels in plasma in CD patients before and after EEN, as well as the differences between response group and non-response group.Results:Thirteen patients were included in the study. The clinical remission rate reached 69.2% (9/13) after 8 weeks of EEN treatment. Compared with pre-treatment, the plasma levels of tryptophan, threonine, alanine, proline and cysteine in CD patients were significantly higher after EEN treatment. At week 8 after EEN, tryptophan metabolites including indole acetic acid and indole acetamide were significantly lower in patients with clinical remission compared to patients without remission. Correlation analysis showed the plasma levels of tryptophan was negatively correlated with CDAI and erythrocyte sedimentation rate (ESR), and the level of kynurenine was negatively correlated with ESR.Conclusion:EEN therapy is an effective way to induce clinical remission in active CD patients. After EEN, plasma levels of tryptophan, threonine, alanine, proline and cysteine are significantly increased. Tryptophan and cysteine metabolisms may be the key pathways leading to the efficacy of EEN treatment.

Objectives:To evaluate the efficacy and safety of adalimumab (ADA) biosimilar in the treatment of Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. The patients with CD treated with ADA biosimilar in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to March 2022 with complete data were enrolled. The disease activity of patients at baseline was evaluated by Harvey-Bradshaw index (HBI) . The patients were divided into active group and remission group according to the activity. The primary endpoints were clinical response rate and remission rate at the 12th week in patients with active CD. The secondary endpoints included the clinical response rate and the remission rate in patients with active CD at the 26th week, maintenance remission rate at the 12th and the 26th weeks in patients with remission CD, and safety report.Results:Forty-eight patients were included. There were 20 patients whose HBI was 7 (6, 8) points in active group and 28 whose HBI was 3 (2, 4) points in remission group. In patients with active CD, the clinical response rate was 70.0% (14/20) and clinical remission rate was 60.0% (12/20) at the 12th week. The clinical response rate and clinical remission rate were both 61.5% (8/13) at the 26th week. The maintain remission rate of patients with remission CD was 96.4% (27/28) and 92.3% (12/13) at the 12th and the 26th weeks respectively. During the follow-up period, adverse reactions occurred in 2 patients (4.2%) and no serious adverse reaction was found.Conclusion:ADA biosimilar has good efficacy and safety in short-term induction and maintenance of clinical remission in Chinese patients with mild to moderate active CD.

Objective:To investigate the effect of exclusive enteral nutrition (EEN) on plasma amino acid levels in patients with Crohn′s disease (CD) .Methods:Adult patients with moderate to severe active CD in the Sixth Affiliated Hospital of Sun Yat-sen University from December 1, 2020 to December 31, 2021 were prospectively recruited. All the participants received nasogastric EEN monotherapy for 8 weeks. Patients were divided into clinical response group and non-response group according to CD activity index (CDAI). Clinical data were collected from all the participants before and after EEN. Targeted metabolomics was used to detect and analyze the changes of 25 amino acids levels in plasma in CD patients before and after EEN, as well as the differences between response group and non-response group.Results:Thirteen patients were included in the study. The clinical remission rate reached 69.2% (9/13) after 8 weeks of EEN treatment. Compared with pre-treatment, the plasma levels of tryptophan, threonine, alanine, proline and cysteine in CD patients were significantly higher after EEN treatment. At week 8 after EEN, tryptophan metabolites including indole acetic acid and indole acetamide were significantly lower in patients with clinical remission compared to patients without remission. Correlation analysis showed the plasma levels of tryptophan was negatively correlated with CDAI and erythrocyte sedimentation rate (ESR), and the level of kynurenine was negatively correlated with ESR.Conclusion:EEN therapy is an effective way to induce clinical remission in active CD patients. After EEN, plasma levels of tryptophan, threonine, alanine, proline and cysteine are significantly increased. Tryptophan and cysteine metabolisms may be the key pathways leading to the efficacy of EEN treatment.

Objective:To analyze the clinical characteristics, therapeutic modalities and prognosis of desmoplastic small round cell tumor (DSRCT) in children, and to summarize the international research progress.Methods:A total of 8 children with DSRCT admitted to Shanghai Children′s Medical Center, Shanghai Jiaotong University, School of Medicine, from January 1999 to August 2019 were retrospectively studied.The clinical characteristics, consultation process and follow-up results were summarized, and the Kaplan-Meier survival analysis method was used to calculate the survival rate.Results:Among these 8 cases, there were 6 male children and 2 female children.Seven cases originated in the abdomen and pelvis, and 1 case originated in the sacral region.All cases had infiltrate surrounding tissues or viscera, and 4 cases(50%) had extra-peritoneal metastasis, including distant lymph node metastasis, liver, lung and bone metastasis.All patients received chemotherapy, among which 3 patients received radiotherapy, and 2 patients received autologous hematopoietic stem cell transplantation.The medical follow-up was continued to February 15, 2020, with the median follow-up period being 59 months.Three cases died and 5 cases survived (2 cases in complete remission, 1 case in recurrent relapse, 2 cases in partial remission still under treatment). The median relapse time was 14.5 months, the 3-year relapse-free survival rate was (30.0±17.5)%, and 3-year overall survival was (51.4±20.4)%.Conclusions:Half of DSRCT had distant metastasis; the prognosis was poor despite the aggressive multimodality therapeutic approaches, such as chemotherapy, cytoreductive surgery, and whole abdominopelvic radiotherapy and stem cell transplantation.

Poor ovarian response (POR) is a reproductive endocrinology disease that seriously affects the number of oocytes retrieved and reduces the success rate of in vitro fertilization (IVF). The double stimulation protocol utilizes the principle of ovarian stimulation in both the follicular and luteal phase. By retrieving oocytes within one menstrual cycle, more oocytes can be obtained in a fairly short period of time. Therefore, to further explore this new ovarian stimulation protocol may help to provide better treatment strategies for POR patients. This paper reviews the definition of POR, the mechanism and developments of double stimulation, and its application in POR patients.

Poor ovarian response (POR) is a reproductive endocrinology disease that seriously affects the number of oocytes retrieved and reduces the success rate of in vitro fertilization (IVF). The double stimulation protocol utilizes the principle of ovarian stimulation in both the follicular and luteal phase. By retrieving oocytes within one menstrual cycle, more oocytes can be obtained in a fairly short period of time. Therefore, to further explore this new ovarian stimulation protocol may help to provide better treatment strategies for POR patients. This paper reviews the definition of POR, the mechanism and developments of double stimulation, and its application in POR patients.

Objective To observe the effects of dual-task motor training on motor and balance function for stroke patients. Methods From January, 2016 to June, 2017, 30 patients with stroke were assigned randomly into control group (n = 15) and treatment group (n = 15). Both groups accepted routine physical therapy, the control group accepted anti-gravity treadmill training, while the treatment group accepted dual-task training with anti-gravity treadmill, for four weeks. They were measured with balance training and evaluation system, and assessed with Fugl-Meyer Assessment-lower extremity (FMA-L), Berg Balance Scale (BBS) and modified Barthel Index (MBI), before and after treatment. Results The range of swaying on X axial (Rx) and Y axial (Ry), as well as rectangle area (RecArea) decreased after treatment in the treatment group (t > 4.719, P < 0.001), while RecArea decreased in the control group (t = 5.069, P < 0.001). Ry and RecArea were less in the treatment group than in the control group (t > 2.288, P < 0.05). The scores of FMA-L, BBS and MBI improved after treatment in both groups (t > 7.316, P < 0.001), and improved more in the treatment group than in the control group (t > 2.322, P < 0.05). Conclusion The dual-task training via anti-gravity treadmill may improve motor and balance function in stroke patients, and promote the activities of daily living.

Objective To explore the pathogenesis of renal damage induced by melamine and the characteristics of kidney damage in rats.Methods Twenty Wister rats were randomly divided into one control group fed with normal pet food and one exposure group fed with animal food mixed with melamine at 25 mg(/kg?d).After 4 weeks,biochemical indexes of blood were determined,histopathological examination was performed,and kidney/body weight was measured among rats.The kidney slices were observed using light microscopy of animal anatomy.Renal tissues from affected rats were analyzed using high-performance liquid chromatography and mass spectrometry.Kidney X-ray diffraction were performed to determine the existence of crystals Results After 4 weeks of melamine exposure,the rats showed polyuria,less activity,weight loss,increasing levels of serum creatinine,urea nitrogen,triglyceride.The appearance of kidney significantly changed.The diffuse distribution of the point and the flake crystal shadow were observed in kidney slices.Histopathological examination showed the existence of a large number of crystals in renal tubular,renal tubular epithelial damage.The analysis of high-performance liquid chromatography and mass spectrometry revealed that crystals were composed of melamine and cyanuric acid.Kidney X-ray diffraction revealed that crystals could be found in kidneys of rats.Conclusion Melamine can enter the body through the digestive tract and generate partially cyanuric acid through hydrolysis.Then cyanuric acid and melamine formed cocrystals in renal tubules leading to progressive tubular blockage,renal tubular epithelial damage,tubular reabsorption dysfunction,eventually renal failure.